Individual
SAMUEL MERRITT UEBELACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2855 E MAGIC VIEW DR, MERIDIAN, ID 83642-6245
(208) 639-4900
Mailing address
2855 E MAGIC VIEW DR, MERIDIAN, ID 83642-6245
(208) 639-4900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1810
ID
Other
Enumeration date
01/14/2020
Last updated
02/27/2020
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